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Letter to the Editor

Published:November 15, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.10.430
      The recently published article, “Physician radiation exposure during endomyocardial biopsy and right heart catheterization,” highlights the role of the transplant and interventional cardiology provider in the care of patients with advanced heart failure.
      • Loyaga-Rendon R.Y.
      • Lee S.
      • Dickinson M.G.
      • Grayburn R.
      • Gonzalez M.
      • Jani M.
      • et al.
      Physician radiation exposure during endomyocardial biopsy and right heart catheterization.
      The authors emphasize that individual practice patterns and proficiency during these procedures can vary the total radiation dose exposure. As previously published, echo-guided biopsy obviates the need to use x-ray devices for catheter manipulation and sample recovery and is considered safe.
      • Bedanova H.
      • Necas J.
      • Petrikovits E.
      • Pokorny P.
      • Kovalova S.
      • Malik P.
      • et al.
      Echo-guided endomyocardial biopsy in heart transplant recipients.
      Our single-center experience has safely used this method over 10 years to perform 3805 biopsies after heart transplantation outside the traditional catheterization laboratory using a special sterile procedure room. In most cases, we have also performed 1960 hemodynamically guided right heart catheterizations without using fluoroscopy. The authors highlight the continued importance of education in complex patient management. In the current climate of coronavirus disease 2019 and the increase in telehealth, our field may benefit from reconsidering ideal resource use, procedural necessity, and future application of newer noninvasive methods to detect cellular rejection with either cell-free DNA testing or broader application of artificial intelligence with an electrocardiogram
      • Ruiz Morales J.
      • Nativi-Nicolau J.
      • Jang J.
      • Patel P.
      • Yip D.
      • Leoni-Moreno J.
      • et al.
      Artificial intelligence 12 lead ECG based heart age estimation and 1-year outcomes after heart transplantation.
      ; however, if an endomyocardial biopsy is indicated, an echocardiography-guided approach in patients with appropriate access should be considered a first-line option.
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      References

        • Loyaga-Rendon R.Y.
        • Lee S.
        • Dickinson M.G.
        • Grayburn R.
        • Gonzalez M.
        • Jani M.
        • et al.
        Physician radiation exposure during endomyocardial biopsy and right heart catheterization.
        J Card Fail. 2022; (2022 Oct 1;S1071-9164-7. Online ahead of print): 00718https://doi.org/10.1016/j.cardfail.2022.09.005
        • Bedanova H.
        • Necas J.
        • Petrikovits E.
        • Pokorny P.
        • Kovalova S.
        • Malik P.
        • et al.
        Echo-guided endomyocardial biopsy in heart transplant recipients.
        Transpl Int. 2004; 17: 622-625https://doi.org/10.1007/s00147-004-0760-1
        • Ruiz Morales J.
        • Nativi-Nicolau J.
        • Jang J.
        • Patel P.
        • Yip D.
        • Leoni-Moreno J.
        • et al.
        Artificial intelligence 12 lead ECG based heart age estimation and 1-year outcomes after heart transplantation.
        J Heart Lung Transplant. 2022; 41: S213https://doi.org/10.1016/j.healun.2022.01.1671